Implementation of guidelines on prevention of coercion and violence (PreVCo) in psychiatry: a multicentre randomised controlled trial

[Implementation of the guidelines on the prevention of violence and coercion: pre-post analysis of the randomized controlled PreVCo study]

AIM OF THE STUDY

This study examines the extent to which a structured implementation of guidelines for the prevention of coercion leads to an improvement in guideline-compliant work and the reduction of coercion in routine clinical practice.

METHODS

This is a secondary analysis of the shift of outcomes in the PreVCo study, which was conducted on 55 psychiatric wards throughout Germany.

RESULTS

The number of coercive measures decreased significantly during the observation period. The degree of implementation of the guidelines increased significantly. This was achieved without an increase in aggressive assaults.

CONCLUSION

The structured implementation of guideline-compliant work is possible in routine operations on psychiatric wards.

Barriers and Facilitators-Lessons Learned From a Randomised Trial to Implement Clinical Practice Guidelines for the Prevention of Coercion in Psychiatry

The PreVCo study ('Prevention of Violence and Coercion') investigated the effects of a structured programme for the implementation of guideline recommendations for the management of aggression and the prevention of violence and coercion in psychiatric hospitals in a multicentre randomised controlled trial with 55 participating wards. The intervention was a 1-year individually tailored implementation programme supported by external consultants. An independent evaluation of the individual wards' process aimed at identifying barriers and facilitators in implementation. We conducted guideline-based group interviews with 53 of 55 participating teams during the implementation process. The Consolidated Framework for Implementation Research (CFIR) was used for the qualitative analysis. Two coders independently coded the transcripts and conducted a summary content analysis. The focus was on facilitators and barriers in the implementation process. The design of the intervention, in particular the framework of a controlled study, external guidance and the opportunity to choose and adapt the implementation programme according to the wards' possibilities and needs, was generally perceived as useful and supportive. The context of pandemic management at the time of the study interfered with the implementation process, mostly because of organisational transformations, challenges for information exchange and increased workload of the staff. With regard to the wards participating in the study, the main facilitators were a receptive, collaborative ward culture, team spirit and previous experiences in successful transformation processes. Barriers included the demanding working situation, frequent fluctuation of staff and low team cohesion, obstacles in communication, a deficit-oriented perception of patients and low priority of the implementation process. Provision of necessary resources by the organisation was not self-evident. Stakeholders devoted to the ideas of transformation of psychiatry and reduction of coercion were important facilitators of the implementation; however, some employees kept a resigned attitude and could not be engaged. The analysis of barriers and facilitators shows that an implementation process of innovative routines on psychiatric wards can benefit from external, individually tailored guidance. However, the working conditions on psychiatric wards remain to be challenging. Trial Registration: Clinical Trial Registration at www.isrctn.com with the identifier ISRCTN 71467851.